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 February Kitzhaber is heading to Washington DC On February 27, Governor John Kitzhaber travels to Washington DC to meet with Tommy Thompson, Secretary of Health and Human Services. He anticipates having high level policy discussions about the Oregon Health Plan, said Mark Gibson, his health policy advisor. The governor will also talk with Bush administration officials about the energy crisis and the impact of federal policy on public lands. Senate President Gene Derfler (R-Salem) and House Speaker Mark Simmons (R-Elgin) are expected to accompany Kitzhaber on the three-day trip. Derfler looks out for small businesses The mandate-free bill proposed by Senate President Gene Derfler (R-Salem) is rolling off the presses. " It makes available affordable health care to small employers, " Theresa Van Winkle, spokesperson, told the Insurance Pool Governing Board. Prescription coverage as well as alcohol and mental health benefits are eliminated, and a group known as the Health Insurance Reform Advisory Committee will be convened to determine the benefit structure and develop maximum deductibles, copayments and coinsurance. Between 2001 and 2005, these maximums would be adjusted based on the Consumer Price Index, and could only be adjusted every five years starting in 2006. Health premiums would be limited to a percentage of the state's average annual wage, again determined by the advisory committee. Employers anxious to gather quality data Health care costs are rising dangerously fast, and the Oregon Coalition of Health Care Purchasers, which represents over 400,000 employees, intends to do something about it. Large employers such as Tektronix, Esco Corp., SAIF Corp, Portland General Electric and Northwest Natural are experiencing increases of 24 percent, Phil Griffin, the coalition's president, told legislators recently. Smaller employers have been hit harder. That's why the coalition is sponsoring legislation giving the Office of Oregon Health Plan Policy and Research, the authority to coordinate health care utilization and quality improvement studies. It would receive $100,000 from the tobacco settlement to spearhead this project. By focusing on best practices and evidence-based medicine, error rates will be reduced and outcomes improved, which will drive down health care costs, Griffin said. " Doctors are besieged with the number of contracts they have and the hospitals where they work, " said Barney Speight, director of public policy and government relations at Kaiser Permanente, who initiated this concept. " Outcome studies are terribly long, complex and research driven. We should work at what's applicable tomorrow for a clinician. It can happen in an ambulatory setting, not one health plan at a time, but by the industry. Then things can start to change. " Advocates debate formulary bill Rising pharmaceutical costs is the biggest health care problem facing Oregon, according to Mark Gibson, the governor's health policy advisor. He's part of a team of health officials, employers and consumers attempting to reach a compromise on a drug formulary bill that Senate Minority Leader Kate Brown (D-Portland) intends to introduce. However, the group is struggling with a major issue -- the exception process -- which assures consumers access to non-formulary medications without having to dig into their pocketbooks. Rep. Alan Bates (D-Ashland), who practices medicine on the weekends, is adamant that doctors should have the final word, not bureaucrats. " I want to get rid of the exception process and leave it up to the professional judgement of the practitioner so we're not being micro-managed, " said Bates, who's a member of the work group. The preferred drug list should be very straightforward and simple for a doctor to use. If a doctor wants a patient to have a drug that's not on the list, he could write the words " do not substitute " on the prescription. Rural health foundation debated It's being called the David Nelson take home bill. A rural legislator, Senate Majority Leader Nelson (R-Pendleton) is determined to establish a $20 million rural health foundation -- the money coming from Medicaid upper limit payments available to Oregon's nine publicly-owned nursing homes. Depending on whose numbers one believes -- the governor's or the co-chair's budget, Oregon is poised to receive between $58-67 million over the next two years. The Oregon Association of Hospitals and Health Systems has its eye on those dollars, but it may not be smooth sailing. The trade association representing the state's 153 nursing homes is anxious to restore $46.5 million in cuts to senior services such as Project Independence. " The governor's budget dramatically reduces rates to providers and eliminates thousands of people from Medicaid, " said Jim Carlson, executive director of the Oregon Health Care Association. The $46.5 million for senior services, unlike the $20 million for the trust fund, is eligible for federal matching dollars. " Prior to starting new programs, we need to maintain the continuing service levels for low-income seniors, " said Carlson. Ed Patterson, vice president of governmental relations for the hospital association, wants the legislation creating this foundation to be as non-restrictive as possible. " Flexibility is the key word, " he said, reminding legislators his association discovered this money source back in 1999. Drug diversion concerns pharmacy board An attempt by the Board of Pharmacy to more tightly control drugs containing hydrocodone --Vicodin-- was defeated following an outcry by pharmacists. The board tried to impose a perpetual inventory and require pharmacists to conduct a monthly inventory and report discrepancies. The theft of controlled substances from pharmacies has reached a serious and alarming level, said Steve Schulte, compliance director, and hydrocodone products are the number one drug stolen. " It's difficult, without doing a drug inventory, to know whether someone is actually diverting this drug," he said. Currently, pharmacies only conduct an inventory once a year, and the yardstick is really long. " It's an inaccurate yardstick because pharmacies don't have to reconcile. " Hospitals, on the other hand, have much stricter standards. They are required to conduct a perpetual inventory every month on hydrocodone products (Schedule III drugs) as well as narcotics such as Morphine and Fentanyl (Schedule II drugs). Also, every time the nursing shift changes, they have to count the pills, Schulte said, " so that there are controls once these drugs leave the pharmacy." When the hospital rule requiring inventories was implemented, there were similar outcries from pharmacists. Planning Commission rejects Salem Hospital Salem Hospital is going back to the drawing boards after the city's Planning Commission turned down its request for a zoning change. The hospital wanted to begin construction on a new $50 million facility in early March. Teachers, parents and officials from a nearby elementary school objected to the hospital's plan because of safety, noise and disruption. In emergency cases, the safety of their children would compete with the health needs of agitated, stressed people using the hospital's emergency department, said Martin Sobelman, a music teacher at Bush School. " The health and safety of our school community will be sacrificed for the health of the hospital," according to his testimony. Sobelman suggested the hospital assist the school to acquire a new site by paying $6 million to take over its current location. " In that manner, they can build whatever and however they wish." Jim Randall, the hospital's marketing director, said the architects and designers will take another look at the layout of the new facility. " We've been working very closely with the school and thought we had reached agreement, " he said. Name reporting of HIV patients takes its toll An HIV activist, Steve Henson, 49, is prepared to die for the cause. He's protesting a decision by the Oregon Health Division that requires people who test positive for the HIV virus to share their names with health authorities. On Dec. 21, when this rule was promulgated, Henson stopped taking his anti-retro-viral medication. For the past three years, Henson had been doing fine. There were no traces of the virus in his bloodstream. But in early January, he was diagnosed with full blown AIDS. His viral load had gone up to 200,000 (200 is normal), and symptoms started appearing -- headaches, lethargy, chronic diarrhea, low grade fevers, night sweats. " It's not my intent to become a martyr, " said the North Bend resident who builds cabinets and boats. " But this is the only avenue I have left. People look to me as their representative. This is the most devastating decision the Oregon Health Division has made in 16 years." Also in this issue...
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